Objectives:In this study, a comparison of cardiac magnetic resonance imaging (MRI) and simultaneous transthoracic echocardiography data were obtained from patients with great artery transposition (TGA), who underwent arterial switch operation (ASO) surgery.In to discover the most effective and optimal viewing method during long-term follow-ups. Materials and Methods:This retrospective cohort included 20 TGA patients (16 male, 4 female), which had ASO surgery.Along with cardiac MRI and transthoracic echocardiography data were obtained from the images.The mean age was 93.00±29.82months (60-144).Seventeen patients had TGA only.However, 3 patients with TGA included an existing ventricular septal defect. Results:We showed a meaningful correlation between echocardiographic variables (left ventricle dilatation of the left ventricle function of the aorta failure, myocardial performance index) and MRI parameters (ejection fraction of left ventricle dilatation of the left ventricle function of the aorta insufficiency).

Background: Congenital Heart Disease (CHD) constitutes a significant cause of morbidity and mortality in newborns. Identifying CHD prenatally and understanding associated risk factors can aid in early diagnosis, intervention, and postnatal management. This study aims to assess risk factors for CHD using prenatal fetal echocardiography (FE) and investigate their correlation with postnatal diagnoses. Patients and Methods: In this study, we included 993 pregnant women presenting to the pediatric cardiology outpatient clinic between December 2018 and December 2020, considered at risk for CHD. We retrospectively evaluated the cases’ postnatal echocardiography data with detected CHD during fetal echocardiography. Results: The average age of the patients was 29.8±5.7, and the mean gestational week was 23.61±3.9. Among the pregnant women, 253 (25.47%) were primiparous, 740 (74.53%) were multiparous, 103 cases (9.32%) involved multiple pregnancies, and 259 (26.08%) had chronic diseases. The most common reason for fetal echocardiography referral was the suspicion of CHD in fetuses with dysmorphic findings detected during obstetric ultrasonography. Among the cases, 329 (33.1%) were classified as low-risk, while 664 (66.9%) as high-risk. Among all patients, the most commonly observed prenatal CHD were Ventricular Septal Defects (VSD) (8.2%), Hydrops Fetalis (6.1%), and large Atrial Septal Defects (ASD) (3.9%). The overall prevalence of CHD was 31.6%. The accuracy of postnatal echocardiography in confirming the diagnoses made with fetal echocardiography was 94%. Conclusion: Prenatal diagnosis of congenital heart diseases is crucial for planning prenatal and postnatal management and providing families with the option of pregnancy termination in severe anomalies. Fetal echocardiography has shown significant potential for early diagnosis of CHD, even in low-risk fetuses, and its inclusion in routine prenatal screenings by increasing the number of experienced specialists and centers could play a crucial role in reducing CHD-related mortality and morbidity rates.

Objectives: Atrial and ventricular arrhythmias can be observed in children after transcatheter atrial septal defect (ASD) closure.This study investigated ventricular repolarization parameters, which are considered to indicate an increased risk of arrhythmias in patients with transcatheter ASD closure. Materials and Methods:The study included 225 patients aged 0-18 years who underwent transcatheter ASD closure at a tertiary medical school university hospital between 2005 and 2020.Heart rate, Pmax, Pmin, Pdispersion, QTmax, QTmin, QTdispersion, QTcmax, QTcmin, QTcdispersion, Tp-e interval, Tp-e/QT, and Tp-e/QTc values were calculated electronically in 12-lead electrocardiographies (ECGs) taken before the procedure and at 24 h, 1, 6, and 12 months after the procedure.

Background. Coronary arterial lesions (CALs) are the major component of Kawasaki disease (KD), associated with significant morbidity, which affect a substantial proportion of patients despite proper treatment. The aim of this study was to define the risk factors for CALs in Turkish children with KD. Methods. Medical records of 399 KD patients from five pediatric rheumatology centers in Turkey were reviewed retrospectively. Demographic, clinical (including duration of fever before intravenous immunoglobulin [IVIG] and resistance to IVIG), laboratory and echocardiographic data were noted. Results. The patients with CALs were younger, had a higher male ratio and a longer duration of fever before IVIG. They also had higher lymphocyte and lower hemoglobin values before the initial treatment. Multiple logistic regression analyses defined the following three criteria as independent risk factors for predicting CALs in Turkish children with KD: age ≤12 months, male gender and duration of fever before IVIG ≥9.5 days. High sensitivity rates of elevated risk of CALs up to 94.5% were calculated despite specificity values falling to 16.5%, depending on which of these three parameters are taken into account. Conclusions. Based on the demographic and clinical features, we established an easily applicable risk-scoring system for predicting CALs in Turkish children with KD. This may be useful for choosing appropriate treatment and follow-up for KD to prevent coronary artery involvement. Further studies will show whether these risk factors can be used in other Caucasian populations as well.

INTRODUCTION:With the development of transcatheter interventional techniques and the introduction of next-generation duct occluder devices, transcatheter closure has become the first treatment option for patent ductus arteriosus (PDA) in pediatric patients. In this study, we compared the effectiveness and safety of different devices for transcatheter PDA closure in pediatric patients, focusing on long-term outcomes.METHODS:A total of 235 patients aged 0-18 years who underwent transcatheter PDA closure at a tertiary care center between January 2005 and February 2020 were included. The medical records of the cases were retrospectively evaluated.RESULTS:The median age of the patients was 2.3 years (range: 3.5 months to 17 years), with a mean weight of 12.8 kg (range: 5.7-43.2 kg). The mean PDA diameter at its narrowest point was 2.9 mm (range: 2.2-5.1 mm). Ductal anatomy was as follows: Type A in 98 (41.7%) patients, Type E in 36 (15.6%) patients, Type C in 32 (13.5%) patients, Type F in 27 (11.4%) patients, Type D in 23 (9.7%) patients, and Type B in 19 (8.1%) patients. Arterial access was used in 138 (57.1%) patients, venous + arterial access in 58 (24.6%) patients, and venous access only in 39 (16.5%) patients. Closure was performed with Amplatzer Duct Occluder (ADO; AGA Medical Corp., Golden Valley, MN, USA) II in 151 (64.2%) cases, ADO I in 43 (18.2%) cases, and coils in 41 (17.4%) cases. The mean fluoroscopy time and mean procedural time were 10.3 ± 4.2 minutes and 41 ± 7.2 minutes, respectively. The mean radiation dose was 1364 ± 497 cGy/min. The early closure rate after the procedure was 92%, while residual shunting on the first day post-procedure was observed in 1.8% of cases, decreasing to 0.1% at the one-month follow-up. The overall procedural success rate for all cases was 96.0%. The mean follow-up duration was 9.7 years (range: 2.9-13.8 years).CONCLUSION:For percutaneous PDA closure, ADO I devices are preferred for larger defects, whereas ADO II devices are prioritized for small- to medium-sized defects instead of coils.

Background: Three-dimensional (3D) echocardiography has facilitated evaluation of a ventricular septal defect (VSD) with its true dimensions and exact localization and improved identification of various anatomical char-acteristics in different types of VSDs. Objectives: We aimed at investigating the feasibility of 3D echocardiography in assessing VSDs in comparison to two-dimensional (2D) echocardiography. Methods: We employed both 2D and 3D echocardiography for measuring the longest diameter of VSD. The morphology, number, and size of the defect as well as its relation and distance to the tricuspid and aortic valves were analyzed by 3D echocardiography displaying the VSD from the right ventricular aspect. The size was defined in terms of maximum area, long and short axis diameters at end-diastole. The longest diameters of VSDs were compared with 2D and 3D echocardiography data in all patients as well as with the intra-operative findings in 17 patients. Results: The mean diameters of end-diastolic VSDs measured by 3D echocardiography from the right ventricular aspect were significantly larger than those obtained by 2D echocardiography (15.6 & PLUSMN; 8.2 vs 10 & PLUSMN; 4.2 mm, P = .02), however, there was a good correlation between them (r = 0.73, P < .001). 3D echocardiography proved to be superior to 2D echocardiography for visualizing the shape of VSD and for measuring tissue rims from the aortic and tricuspid valves. The advantage was prominent in particular for viewing defects hidden by a ven-tricular septal aneurysm or a tricuspid septal leaflet, which can be erased digitally to reveal the VSD underneath. The dimensions of VSDs obtained by 3D echocardiography (r = 0.85, P < .001) correlated significantly better with actual dimensions revealed during surgery as compared to those obtained by 2D echocardiography (r = 0.53, P = .03). Conclusions: The study demonstrated that 3D echocardiography provides more reliable information from both qualitative and quantitative aspects regarding the morphology, size, and tissue rims of VSD compared to 2D views.

Two‐dimensional speckle‐tracking echocardiography (2D‐STE) is a novel method that allows the assessment of regional myocardial function. The aim of our study was to use 2D‐STE to assess left ventricular deformation in patients with coarctation of the aorta (CoA).

This study aimed to document early left ventricular (LV) dysfunction in chronic kidney disease (CKD) using methods such as tissue Doppler imaging and the myocardial performance index (MPI).

Ectopia cordis is a rare congenital disorder in which the heart is partially or completely located outside the chest cavity. In this article, we present four cases of ectopia cordis accompanied by cardiac abnormalities with either thoracic and/or abdominal placed heart, managed with strategies ranging from follow-up without any intervention to complete surgical closure.

BACKGROUND:Cystic fibrosis may lead to left ventricular (LV) dysfunction. This dysfunction can be documented by methods such as tissue Doppler echocardiographic (TDI) imaging and two-dimensional speckle tracking echocardiography (STE) in early stage. STUDY DESIGN:This was prospective cohort study. METHODS:A total of 34 patients diagnosed with cystic fibrosis (mean age and SD 9.9 ± 4.9 years) and 37 healthy control subjects with a comparable gender and age distribution (mean age 9.8 ± 4.3) were studied. The results for the two groups were compared along with the results of published reports. RESULTS:No significant relationship was found between the groups in terms of systolic and diastolic measurements of the interventricular septum and posterior left ventricular wall, and ejection fraction (P > .05). Myocardial performance indexes of left ventricular free wall and interventricular septum increased in the patient group compared with the controls (P < .05). As measured by STE, seven segments in the LV myocardial longitudinal strain and three segments in the LV myocardial circumferential strain showed significant reductions in patients with cystic fibrosis compared with controls (P < .05). The longitudinal global, circumferential global, and total global strain values had no significant difference between the groups (P > .05). Longitudinal strain rates and circumferential strain rates were both lower in five segments in the patient group (P < .05). CONCLUSIONS:Tissue Doppler echocardiographic imaging and STE may help identifying subclinical LV dysfunction in cystic fibrosis patients with unremarkable conventional echocardiography. They may be considered for the routine follow-up of cystic fibrosis patients.

Inflammatory myofibroblastic tumor (IMT) is a rare soft tissue tumor of the heart. In the literature, cardiac IMT is often described as an endocardial-based cavitary mass originating from the right side of the heart in infants and adolescents. In this article, we present a 5-year-old boy with a rare cardiac IMT who had no complaints and was diagnosed with murmur during his routine examination. Transthoracic echocardiography showed a homogeneous polypoid mass originating from the pulmonary valve, extending into the main pulmonary artery during systole and causing obstruction of the pulmonary artery and right ventricular outflow tract. Surgical resection of the tumor was performed successfully. There was no tumor recurrence in the control echocardiography at the postoperative first month.

BACKGROUND AND AIM:Chronic kidney disease may lead to left ventricular dysfunction. Early detection of cardiovascular disease in children with chronic kidney disease is essential to prevent cardiovascular morbidity and mortality in early adulthood. This study aimed to document the dysfunction using methods such as two-dimensional speckle-tracking echocardiography in the early stage.METHODS:A total of 34 patients diagnosed with chronic kidney disease (mean age ± standard deviation, 10.5 ± 4.1 years) and 37 sex- and age-matched (mean age 9.8 ± 4.2 years) healthy controls were studied. The results of the two groups were compared along with those of the published studies.RESULTS:The echocardiography measurements had no significant difference in the end-diastolic and end-systolic diameter values of left ventricular, ejection fraction, shortening fraction, mitral E value, mitral A value, and E/A ratio between the groups. Pulmonary artery systolic and diastolic pressure and left ventricular mass index were significantly higher in the patient group (p < 0.01). The longitudinal global strain values in the apical four-chamber, three-chamber, and two-chamber views and the total global strain values were significantly lower in the patients (p < 0.01). The circumferential global strain values in the apical, mid, basal, and total global strain were lower in the patient group, but this difference was statistically significant in the apical global and total global strain values (p < 0.05).CONCLUSIONS:Speckle-tracking echocardiography might help identify subclinical left ventricular dysfunction in patients with chronic kidney disease with unremarkable conventional echocardiography.

PURPOSE:This study was conducted to investigate the symptom frequency and parental care burden of the children with congenital heart disease in predicting the quality of life of parents in Turkey.DESIGN AND METHOD:The study subjects for the present study included 124 parents whose children were suffering from heart disease. The data for the study were collected from these parents using parent information form, the questionnaire of the frequency of heart disease-related symptoms of the child, the caregiver burden scale, and the quality of life scale. The level by which the heart disease-related symptoms of the child and caregiver burden predicted the quality of life was analyzed using the regression analysis.RESULTS:The most common symptoms in children were found to be anorexia, difficulty in activities, palpitations, shortness of breath, weakness, and fatigue. The number of symptoms observed in children and the care burden of the parents were determined to explain 27.1% of the psychological health sub-dimension, 14.4% of the social relations sub-dimension, and 34.9% of the environment sub-dimension. When the variables were examined separately, the number of symptoms was found to significantly predict only social relations sub-dimensions.CONCLUSION:Increased number of symptoms increased parental care burden. Increased number of symptoms and care burden of parents reduced the quality of life of parents.PRACTICE IMPLICATIONS:Symptom management is one of the important responsibilities of nurses in improving care burden and quality of life for parents of children with heart disease.

ÖZAmaç: Çalışmamızda çocuklarda soldan sağa şantlı doğumsal kalp hastalıklarında serum kardiyotrofin-1 (CT-1) düzeyleri ile şant miktarının karşılıklı etkileşimlerini araştırmak, bu belirtecin intrakardiyak defekt tipine göre değişimlerini incelemek amaçlanmıştır

Objective: We assessed the effect of anemia on cardiovascular findings in obese adolescents. Materials and Methods: We studied 29 anemic and 33 nonanemic obese adolescents, and 33 nonobese healthy adolescents. These three groups were investigated for clinical and laboratory features of anemia and obesity. Echocardiography was used to examine cardiac functions. Results: The anemia was mild (mean hemoglobin: 11.67±0.79 g/dL), ferritin level was significantly low, and C-reactive protein and fibrinogen levels were significantly high in anemic obese patients. Increased cardiac pulse and echocardiographic findings, which may be indicative of early left ventricular diastolic dysfunction, were present in these patients. Conclusion: Anemia may develop due to iron deficiency and chronic inflammation in obese adolescents. Even mild anemia may cause increased heart rate and affect left ventricular diastolic functions. Diet programs for obese children should be carefully planned to avoid iron deficiency anemia, which may worsen the cardiac events in long-term follow-up.

Homozygous familial hypercholesterolemia (HoFH) is a result of a defect in low-density lipoprotein (LDL) receptor gene located on the short arm of chromosome 19 which leads to inadequate clearance of lipoproteins from blood circulation. Homozygous and heterozygous types are available. In homozygous types coronary lesions emerge due to early atherosclerosis in the first decade of life, and untreated patients are lost generally when they are 20 years of age. Our patient was admitted to our outpatient clinic with the complaint of exertional chest pain six months after diagnosis of familial hypercholesterolemia. Coronary angiography was performed because of the patological exercise stress test. Significant coronary artery stenosis was detected. Then the patient successfully underwent coronary bypass grafting. This case is presented to highlight that coronary lesions may develop at an early disease stage of the patients with hyperlipidemia.

yılında dünya sağlık örgütü (WHO) tarafından kardiyomiyopatiler primer ve sekonder olarak ikiye

Doksöz Ö, Nacaroğlu HT, Ceylan G, Çeleğen M, Aşık-Nacaroğlu Ş, Can D, Meşe T, Ünal N. The evaluation of right and left ventricular functions in children with episodic wheezing exposed to environmental tobacco smoke. Turk J Pediatr 2017; 59: 42-48. The objective of this study is to examine the right and left ventricular functions in children with episodic wheezing at the ages of 1-3 exposed to environmental tobacco smoke (ETS). Thirty-two children monitored at the Pediatric Allergy and Immunology Department of a Research and Training Hospital with the diagnosis of episodic wheezing were included. The prospective assessment of the patients was performed between May 2013 and February 2014. Twenty-five children with episodic wheezing not exposed to ETS formed the control group. The two groups were compared by conducting transthoracic two-dimensional and tissue Doppler echocardiography (TDE) examination in all of the cases. The average age of the study group (24 boys, 8 girls) was 33.1 ± 8.8 months, the average age of the control group (18 boys, 7 girls) was 31.9 ± 11.9 months. There was no statistically significant difference between the two groups in terms of age, gender, weight, height, and body mass index values. There was no statistically significant difference between the two groups for the right and left ventricular systolic and diastolic functions in the conventional echocardiographic measurements, and for the measurements of TDE. Limited number of patients is a major limitation of the study. These results should be supported by more comprehensive studies.

Escherichia coli cause severe infections in newborns, neutropenic cancer patients, and patients with an underlying disease. Production of β-lactamase is one of the main mechanisms for resistance to β-lactam antibiotics. Consequently, infections with extended-spectrum β-lactamase (ESBL)–positive E coli have high morbidity and mortality rates. The aim of this retrospective study was to determine the risk factors and antimicrobial susceptibilities of ESBL-positive E coli among children hospitalized in Dr. Behcet Uz Children's Hospital between 2007 and 2012. Patients with ESBL-positive and ESBL-negative E coli blood cultures were grouped as the patient group and control group, respectively. Cultures taken within the first 48 hours of hospitalization were excluded from the study to minimize the impact of community-based positive blood cultures. Identification of E coli in blood samples was performed using a BacT/ALERT (bioMérieux, Marcy-l'Étoile, France) automated system, blood agar medium, and a VITEK2 (bioMérieux) compact system. Susceptibility of the isolates by determination of the minimum inhibitory concentrations was performed by VITEK2 (bioMérieux). SPSS 15 software (SPSS Statistics; IBM Inc., Armonk, NY) was used for statistical analyses. The χ2 and Fisher exact tests were used for categorical quantitative variables, and the Mann-Whitney U test was used for continuous variables. P < .05 was considered to be statistically significant. A total of 25 patients and 45 controls were included in this retrospective case-control study. ESBL positivity in E coli in our setting was 35%. Patient characteristics and factors examined in this study are shown in Table 1. There was no significant differences in terms of sex, age, total duration of hospitalization, hospitalization within 1 year, using total parenteral nutrition, or invasive procedures between groups (P > .05). The mean time for detection of culture positivity among hospitalization in the ESBL-negative group was significantly higher than the mean time in the ESBL-positive group (17 vs 6 days, respectively; P = .04). Fourteen patients (56%) had long-term use of antibiotics (>10 days) in the ESBL-positive group, whereas 11 patients (24.4%) had long-term use of antibiotics in the ESBL-negative group (P = .01). Eleven patients (44%) had a history of using third-generation cephalosporin in the ESBL-positive group, whereas only 6 patients (13.3%) had an history of using third-generation cephalosporin in the ESBL-negative group (P = .04). There was no difference for using other antibiotics between groups. The most frequent chronic disease in both groups was hematologic malignancy (22/70 patients). Antimicrobial susceptibilities of E coli were also studied in our study. Tobramycine had the highest rate for resistance to E coli (88.5%). No resistance was found in carbapenems against E coli.Table 1Patient characteristicsCharacteristicsPatients with ESBL-positive Escherichia coli (n = 25)Patients with ESBL-negative E coli (n = 45)P valueDemographic parameters Median age, mo712.83 Sex, male15 (60.0)26 (57.8).85Duration, median (min-max), d Of hospitalization30 (12-360)2 (3-188).07 For detection of culture positivity among hospitalization17 (3-130)6 (3-170).04Invasive procedures Urinary catheter5 (20.0)7 (15.6).63 Central venous catheter6 (24.0)12 (26.7).80 Nasogastric tube13 (52.0)13 (28.9).05 Mechanical ventilation9 (36.0)10 (22.2).21 Thoracic drainage3 (12.0)2 (4.4).34 Major surgery3 (12.0)6 (6.7).65Other Antimicrobial therapy lasting >10 d14 (56.0)11 (24.4).01 Prior use of third-generation cephalosporin11 (44.0)6 (13.3).04NOTE. Values are n (%) or as otherwise indicated.ESBL, extended-spectrum β-lactamase; max, maximum; min, minimum. Open table in a new tab NOTE. Values are n (%) or as otherwise indicated. ESBL, extended-spectrum β-lactamase; max, maximum; min, minimum. ESBL positivity in E coli in our setting was similar to frequencies found in other reports.1Kim Y.K. Pai H. Lee H.J. Park S.E. Choi E.H. Kim J. et al.Bloodstream infections by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children: epidemiology and clinical outcome.Antimicrob Agents Chemother. 2002; 46: 1481-1491Crossref PubMed Scopus (306) Google Scholar, 2Cordery R.J. Roberts C.H. Cooper S.J. Bellinghan G. Shetty N. Evaluation of risk factors for the acquisition of bloodstream infections with extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species in the intensive care unit; antibiotic management and clinical outcome.J Hosp Infect. 2008; 68: 108-115Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar Several studies reported the risk factors for ESBL-positive E coli bacteremia. Among these studies, length of stay in the intensive care unit, long-term use of antimicrobials, mechanical ventilation, prior colonization, and presence of excess intravascular devices were found to be risk factors for bacteremia.2Cordery R.J. Roberts C.H. Cooper S.J. Bellinghan G. Shetty N. Evaluation of risk factors for the acquisition of bloodstream infections with extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species in the intensive care unit; antibiotic management and clinical outcome.J Hosp Infect. 2008; 68: 108-115Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 3Kang C.I. Song J.H. Chung D.R. Peck K.R. Lee N.Y. Song J.H. Risk factors and treatment outcomes of community-onset bacteraemia caused by extended-spectrum beta-lactamase-producing Escherichia coli.Int J Antimicrob Agents. 2010; 36: 284-287Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar Because the mean time for detection of culture positivity among hospitalization in the ESBL-positive group is higher, we could suggest that prolongation of hospitalization is a risk factor for ESBL-positive E coli bacteremia. In our study, antimicrobial therapy lasting for >10 days and prior use of third-generation cephalosporins were found to be significant risk factors for ESBL-positive E coli bacteremia, which supported the previous reports.2Cordery R.J. Roberts C.H. Cooper S.J. Bellinghan G. Shetty N. Evaluation of risk factors for the acquisition of bloodstream infections with extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species in the intensive care unit; antibiotic management and clinical outcome.J Hosp Infect. 2008; 68: 108-115Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar, 3Kang C.I. Song J.H. Chung D.R. Peck K.R. Lee N.Y. Song J.H. Risk factors and treatment outcomes of community-onset bacteraemia caused by extended-spectrum beta-lactamase-producing Escherichia coli.Int J Antimicrob Agents. 2010; 36: 284-287Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar, 4Zaoutis T.E. Goyal M. Chu J.H. Coffin S.E. Bell L.M. Nachamkin I. et al.Risk factors for and outcomes of bloodstream infection caused by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species in children.Pediatrics. 2005; 115: 942-949Crossref PubMed Scopus (127) Google Scholar, 5Hsieh C.J. Shen Y.H. Hwang K.P. Clinical implications, risk factors and mortality following community-onset bacteremia caused by extended-spectrum β-lactamase (ESBL) and non-ESBL producing Escherichia coli.J Microbiol Immunol Infect. 2010; 43: 240-248Abstract Full Text PDF PubMed Scopus (36) Google Scholar ESBL production in E coli has been increasing, which limits the treatment choices. In our opinion, the best strategy to prevent ESBL occurrence is to limit unnecessary third-generation cephalosporin treatment and to avoid longer antimicrobial treatments. Antimicrobial stewardship will be an important solution in the future.